Provider Demographics
NPI:1932833936
Name:BONILLA, ELIZABETH (AUD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 N ELM ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2733
Mailing Address - Country:US
Mailing Address - Phone:336-542-2015
Mailing Address - Fax:336-542-2017
Practice Address - Street 1:3824 N ELM ST STE 201
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2733
Practice Address - Country:US
Practice Address - Phone:336-542-2015
Practice Address - Fax:336-542-2017
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30000697231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist